by Lauren12 » 10 May 2013, 08:50
Hi becsbum
I had LIS just over two years ago and I've formed further fissures twice since then, the second time only a week and a half ago.
What happened with me on these occasions was that the fissure was as painful as my fissure pre-LIS for just one day, then it started healing and healed within about two weeks. So, I spent one day laying in bed for hours in pain, as I used to do when I had the chronic fissure pre-LIS, and then the very next day I was able to function normally again. I could feel I had a (healing) fissure for a couple of weeks afterwards (a week and a half in the most recent case as it's still healing up), but it didn't interrupt normal life - I could just ignore the sensation.
I did want to know if this kind of thing would keep happening however, and what the best thing to do about it was, so I went back to see the CRS who'd done the LIS.
He examined me (last Wednesday) and said yes, I had a fissure which was mostly healed up (bear in mind it's become mostly healed up within one and a half weeks and for all of that time except for one day, it hasn't bothered me). He said that the muscle tone in my internal sphincter is still quite high. Apparently the average length for the internal sphincter is one centimetre, whereas mine is longer than average at 2 centimetres, with quite good muscle tone in addition. He said I had the anal sphincter of a 25 year old male, whereas I'm a 59 year old woman! I said that I wished more areas of my body were like they were only 25 years old!
He said that he didn't want to go back to surgery to cut further into the muscle and said that if he was doing the operation again, he still wouldn't cut to a further degree. The fissures post LIS happened both times because of a combination of change of diet/dehydration from hot weather/large stools/constipation. After this second time, I started on Movicol again, not having used a stool softener since I'd recovered from surgery. I take less than the minimum recommended dose each day, just half a sachet which, in conjunction with the rest of my diet, is enough to keep my stools reliably soft throughout. So prevention is one thing. After the LIS, you can't just revert to eating any old thing, but have to keep to a healthy diet - but I'm sure you kow that anyway.
So I asked him that if this occurs again, can he guarantee that it will always heal rapidly and he said "pretty much". He said if it happens again and seems to be taking a bit longer to heal, e.g. a week(!) then to come back and he'd do a shot of botox. But he seemed pretty reassuring that if it does happen again, then again it will heal rapidly and not really cause me any bother in the process.
However after this last time when it happened, I reintroduced a low level of a stool softener (Movicol) to keep my stools soft (I didn't do that the first time it happened). So I asked him whether it would have healed had I not re-introduced Movicol and he said it would still have healed. However the best thing is prevention. I asked him if Movicol was something I could take for the rest of my life, to avoid times when my bowel habit becomes disrupted by stress or whatever and he said yes. He checked his formulary and went through every possible contraindication of long term use of Movicol and discounted them all in my particular case. So I'm going to continue to take it. He said that constipation is an individual thing, like bowel habit, and different people find different measures work for them (or don't) and it's necessary to experiment with different things or combinations of things to get the right bowel habit for you. Bowel habit also is very individual with some people's normal bowel habit being to go several times a day whereas others have days where they don't go - the important thing is that whatever people's bowel habit, they don't feel blocked and of course, the stools are of good quality.
So it seems that the problems I had with fissures in the first place are largely due to my individual anatomy (the 2 cm long internal sphincter and high muscle tone) - and there was I thinking it was all due to stress/lifestyle/diet, etc. - although those things may well have contributed, who knows. However he said on the good side, I'll never develop incontinence in old age, as frequently happens to elderly women!
If you're still developing fissures, I'd ask the CRS why that is. I wanted to know why I was still developing fissures and what the prognosis was for my life span. I see you've got an appointment with a second CRS coming up - or you could ask the first one for an explanation.
All the best, and let us know what the CRS says!